Análisis de las Secuelas Neurobiológicas y Legales tras eventos de Encefalopatía Hipóxico-Isquémica Neonatal, Evaluando la Responsabilidad Médica y el Impacto Psiquiátrico a Largo Plazo en la Madre (tept).
DOI:
https://doi.org/10.70577/asce.v5i3.1066Palabras clave:
Hipoxia-Isquemia Encefálica; Responsabilidad Legal; Trastornos por Estrés Postraumático; Daño Cerebral Crónico; Malpraxis; Peritación Forense; Salud Mental Materna.Resumen
La encefalopatía hipóxico-isquémica neonatal (EHI) constituye una causa mayor de morbilidad neurológica y plantea complejos escenarios de responsabilidad médica. Adicionalmente, el impacto psiquiátrico en las madres, específicamente el trastorno de estrés postraumático (TEPT), ha sido insuficientemente abordado en su dimensión a largo plazo. Objetivo: Analizar sistemáticamente la evidencia disponible sobre las secuelas neurobiológicas de la EHI en el neonato, el impacto psiquiátrico materno (TEPT) a largo plazo y su consideración en los procesos de responsabilidad médica. Revisión sistemática realizada siguiendo los lineamientos PRISMA 2020. Se buscó en PubMed/MEDLINE, Scopus, Web of Science, PsycINFO y LILACS (enero 2000-octubre 2025). Se incluyeron estudios originales, revisiones sistemáticas, metaanálisis y guías clínicas que abordaran EHI, secuelas neurológicas, TEPT materno o responsabilidad médica. La calidad metodológica se evaluó mediante las herramientas JBI y AMSTAR-2. Resultados: Se identificaron 1,245 registros, de los cuales 48 estudios cumplieron los criterios de inclusión. La evidencia confirma que la EHI genera secuelas neurológicas en el 25-45 % de los supervivientes (parálisis cerebral, epilepsia, trastornos del neurodesarrollo). La prevalencia de TEPT en madres oscila entre el 15-35 %, asociándose a desregulación del eje HHA y alteraciones en neuroimagen funcional, con persistencia sintomática superior a los 24 meses en el 35 % de los casos. Los litigios por responsabilidad médica se centran en la monitorización intraparto (58 % de los casos), demora en cesárea (42 %) y reanimación inadecuada (28 %). Solo el 15 % de las sentencias analizadas consideran el daño psíquico materno de forma autónoma Los hallazgos respaldan la implementación de cribado sistemático de TEPT en madres de neonatos con EHI, el desarrollo de protocolos periciales estandarizados para la valoración del daño psíquico materno, y la necesidad de estudios longitudinales que evalúen intervenciones preventivas integradas. El daño neurológico infantil y el TEPT materno son secuelas interconectadas de un mismo evento. Su abordaje requiere perspectiva biopsicosocial y jurídica, con inclusión de la salud mental materna en la valoración pericial del daño indemnizable.
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Derechos de autor 2026 Magaly Stefania Inga Ordoñez , Lucía Daniela Serrano Barahona , Evelyn Odalis Checa Paspuezán , David Fernando Moretta Cardenas , Roxana Esther Mayorga Nuñez
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